The 7.5 Million Insured Through Obamacare Are Only Part Of The Story

President Obama announced in early April that more than 7 million people had signed up for health insurance through the exchanges.

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Originally published on April 30, 2014 12:19 pm

Want to know how many people have signed up for private insurance under Obamacare? Like the health care law itself, the answer is complicated.

The Obama administration is tracking the number of plans purchased on HealthCare.gov and on the state exchanges, and this month reported that it had exceeded expectations by signing up 7.5 million people. In addition, federal officials have said that 3 million people have enrolled in Medicaid this year.

But what's often overlooked is that enrollment in private health plans outside the marketplaces is also booming.

The federal government hasn't been counting the number of people who buy new plans directly from insurance carriers — and that number could be substantial. When Alaskan insurance broker Joshua Weinstein wanted to sign someone up for health insurance this year, he asked one key question — would they qualify for a federal subsidy?

If they did, it was worth signing them up through HealthCare.gov to make sure they got that substantial reduction in their monthly premium. But if they made too much money to qualify for subsidy, he says, he steered them away from HealthCare.gov.

"If you can avoid that whole level of bureaucracy and get a good plan — not necessarily at a good price, but at the same price — and they're not eligible [for a subsidy], we're going off the marketplace," Weinstein says.

One of those clients is Oliver Korshin of Anchorage. Weinstein and Korshin worked together to enroll Korshin's wife, Rachel, in a new health plan. She didn't qualify for a subsidy, so they went directly to the insurance firm Premera Alaska.

"The actual enrolling wasn't difficult at all," Korshin says.

Weinstein estimates that about 15 percent of his clients are signing up for insurance outside the exchanges. He says enrolling directly with insurers is easier because they don't need the financial information that's required on HealthCare.gov.

With private insurance companies, signing up means "basically gathering demographic information — name, address, phone number, Social Security number," Weinstein says. Once the client decides which plan they want, and how they want to pay the monthly bill, they just sign the application, he says, "and off you go."

Alaska's two main insurers say more than 20 percent of their customers in the recent open enrollment period bought plans from them directly. But these customers aren't being tallied by the Obama administration.

Larry Levitt, an insurance expert with the Kaiser Family Foundation, says there's a lot of focus on the 7.5 million people who signed up through the 14 state exchanges or HealthCare.gov. But the off-exchange number is just as essential to gauging how well the law is working, he says. "I think it's probably the case that there are more people insured in the individual market off the exchange than on the exchange right now."

In fact, a new survey from RAND Corp. estimates that 7.8 million people nationwide bought health insurance between September and mid-March directly from a carrier.

This story is part of a partnership with NPR, Alaska Public Radio Network andKaiser Health News.

It is now believed that seven-and-a-half million Americans have signed up for health insurance through state and federal marketplaces like Healthcare.gov. But that number does not include people buying plans directly from insurance companies and brokers.

As Alaska Public Radio Network's Annie Feidt reports, that could mean the sign-up numbers under Obamacare are even higher.

ANNIE FEIDT, BYLINE: When insurance broker Joshua Weinstein wanted to sign someone up for health insurance this year, he asked one key question: Would they qualify for a federal subsidy? If the client didn't, he steered them away from Healthcare.gov.

JOSHUA WEINSTEIN: If you can avoid that whole level of bureaucracy and get a good plan - not necessarily at a good price, but at the same price - and they're not subsidy eligible, we're going off the marketplace.

FEIDT: One of those clients is Oliver Korshin, of Anchorage. Weinstein and Korshin worked together to enroll Korshin's wife, Rachel, in a new health plan. She didn't qualify for a subsidy, so they went directly to Premera, Alaska, says Korshin.

OLIVER KORSHIN: The actual enrolling wasn't difficult at all.

FEIDT: Weinstein, their broker, estimates about 15 percent of his clients are signing up for insurance outside the exchanges. He says enrolling directly is easier, because insurers don't have to deal with the financial information required on Healthcare.gov.

WEINSTEIN: It's basically gathering demographic information: name, address, phone number, Social Security Number, which plan do you want, sign up for how you want to pay your bill - monthly via statement or auto-draft - and sign, and off you go.

FEIDT: Alaska's two main insurers report more than a fifth of their customers bought plans directly from them. But these customers aren't being counted by the Obama administration.

LARRY LEVITT: That's the big mystery.

FEIDT: Larry Levitt is an insurance expert with the Kaiser Family Foundation. Levitt says there's a lot of focus on the 7.5 million people who signed up through the 14 state exchanges or Healthcare.gov. But he says the off-exchange number is just as essential to gauge how well the law is working.

LEVITT: Oh, I think it's quite important. I mean, I think it's probably the case that there are more people insured in the individual market off the exchange than on the exchange right now.

FEIDT: In fact, a new survey from the RAND Corporation estimates 7.8 million people nationwide bought health insurance, between September and mid-March, directly from a carrier.

For NPR News, I'm Annie Feidt, in Anchorage.

GREENE: Annie's story is part of a reporting partnership with NPR, Alaska Public Radio Network and Kaiser Health News. Transcript provided by NPR, Copyright NPR.